Provider Demographics
NPI:1609442581
Name:SUCHDEVE, SHAWN ROOP (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:ROOP
Last Name:SUCHDEVE
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6900 DANIELS PKWY STE 29-203
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13701 CYPRESS TERRACE CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8828
Practice Address - Country:US
Practice Address - Phone:239-277-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant